Non-Preferred Provider

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Non-Preferred Provider


Usually a provider who doesn’t have a contract with your health insurer or plan to provide services to you.

Recently, this term has been used to describe a provider that is in the plan's network but is not the plan's "preferred" provider.

The plan is trying to encourage you to use a "preferred" provider because they have negotiated a lower price from this provider.

♦ Your plan may allow you to use a non-preferred provider but you will pay more to see a non-preferred provider.

If the provider is not in your plan's network you may have to pay all costs.

An example, you pay $5 copay for a generic prescription at CVS because they are preferred but have to pay $10 copay at Publix because they are non-preferred.

♦ Be sure to read your plan's documents and understand how your plan uses this term.

Some insurance plans refer to non-preferred providers as non-participating providers. In this case, they are referring to a provider that is not in the plan's network.